Interest has grown in reducing the size of laparoscopic instruments. We define as "needlescopic" those instruments that have a diameter of < or =3 mm. We compared data from 60 needlescopic cholecystectomies with a matched group of laparoscopic procedures. No intraoperative complications occurred in either group. Operative time was 20% longer for the needlescopic operations. Hospital stay was similar for both groups. Postoperative analgesia requirements for the needlescopic group were 70% lower than for the laparoscopic group. From a scale (0, no scar visible, to 10, worst scar), patients scored their scars as 1 for the needlescopic cases and 5 for the laparoscopic group. Likewise, we have used needlescopic instruments to perform appendectomy, inguinal herniorrhaphy, adrenalectomy, splenectomy, and fundoplication. In conclusion, needlescopic procedures are safe and efficient. While they result in longer operative times, they decrease the need for postoperative analgesia, which may shorten convalescence and improve the cosmetic result.